A Comparative Review of Mandibular Orthognathic Surgeries with a Focus on Intraoral Vertico-sagittal Ramus Osteotomy

Puhan He; Joe Iwanaga; Yuki Matsushita; Nimer Adeeb; Nitsa Topale; R Shane Tubbs; Jingo Kusukawa

doi:10.7759/cureus.1924

A Comparative Review of Mandibular Orthognathic Surgeries with a Focus on Intraoral Vertico-sagittal Ramus Osteotomy

Cureus. 2017 Dec 8;9(12):e1924. doi: 10.7759/cureus.1924.

Authors

Puhan He¹, Joe Iwanaga², Yuki Matsushita³, Nimer Adeeb⁴, Nitsa Topale⁵, R Shane Tubbs^{6

7

8}, Jingo Kusukawa⁹

Affiliations

¹ Harvard School of Dental Medicine, Harvard University, Cambridge, USA.
² Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA.
³ Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, USA.
⁴ Neurosurgery, Louisiana State University, Shreveport, USA.
⁵ Basic Sciences, St. George's University, True Blue, GRD.
⁶ Neurosurgery and Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA.
⁷ Anatomical Sciences, St. George's University, True Blue, GRD.
⁸ Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA.
⁹ Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, JPN.

Abstract

Severe dentofacial deformities require both orthodontics and surgical management to repair. Modern mandibular orthognathic surgery commonly uses sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) methods to treat patients. However, complications like neurosensory disturbances and temporomandibular joint disorders are common following both procedures. In 1992, Choung introduced the intraoral vertico-sagittal ramus osteotomy (IVSRO) which led to a decrease in postoperative complications. The 'straight' IVSRO or Choung's type II osteotomy has a 'condylotomy' effect that reduces iatrogenic temporomandibular joint symptoms and treats preoperative temporomandibular joint symptoms. This osteotomy type is especially applicable for prognathism with excessive flaring of the ramus and with temporomandibular joint dysfunction. The 'L-shaped' IVSRO or Choung's type I osteotomy is indicated for patients with condylar hyperplasia and high condylar process fractures.

Keywords: condylar fracture; condylar hyperplasia; condylotomy; intraoral vertical ramus osteotomy; intraoral vertical sagittal ramus osteotomy (ivsro); oral surgery; orthognathic surgery; prognathism; sagittal split osteotomy; temporomandibular joint (tmj).

Publication types

Review